Healthcare Provider Details

I. General information

NPI: 1669532347
Provider Name (Legal Business Name): JAVAKA K MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 PENNSYLVANIA AVE STE 305
FORESTVILLE MD
20747-4764
US

IV. Provider business mailing address

7610 PENNSYLVANIA AVE SUITE 305
FORESTVILLE MD
20747
US

V. Phone/Fax

Practice location:
  • Phone: 301-669-1870
  • Fax:
Mailing address:
  • Phone: 301-669-1870
  • Fax: 301-669-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0065087
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: